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    Liability in ob/gyn ultrasound

    Adhering to best practices for ultrasound can help reduce the chances of a lawsuit related to use of the technology.


    Inadequate or incomplete studies

    Ultrasound studies should include adequate images to allow appropriate diagnosis. Incomplete studies increase liability, particularly in the case of missed diagnoses. Studies should conform to guidelines of national organizations such as the American Institute of Ultrasound in Medicine (AIUM)and the American College of Obstetricians and Gynecologists (ACOG),4,as to the required images for each type of obstetrical or gynecologic study, appropriate measuring criteria, and documentation standards. Following such guidelines enhances the quality of ultrasound studies and helps mitigate liability. For instance, the standard obstetric ultrasound examination includes a complete anatomic survey, including evaluation of the cardiac outflow tracts. Performing a limited ultrasound, such as for dating purposes, does not meet the required elements of a complete obstetrical ultrasound. In such circumstances, a complete anatomic survey, included in the standard obstetric ultrasound, should be performed at the next available opportunity during the pregnancy.  If findings during antepartum screening or ultrasound warrant further evaluation, the patient should be referred for a specialized examination, the “detailed” or “targeted” ultrasound.Performing an incomplete study increases the chance of missing significant fetal abnormalities and the risk of incurring significant liability.


    Exceptions for limited or focused examinations

    In 2009, AIUM and the American Society for Reproductive Medicine published a consensus statement that ultrasounds performed for follicular monitoring were within the scope of practice of a nurse with specific training in ultrasound and with appropriate physician supervision in an infertility practice.The consensus included a statement that a comprehensive ultrasound examination should have been performed within the prior 4 to 6 months to exclude significant gynecologic abnormalities.

    Recommended: Using ultrasound to recognize fetal anomalies: Part 1

    Supervision requirements

    There are 3 levels of supervision for imaging studies: general, direct, and personal supervision. With general supervision, the physician’s presence is not required during the performance of the procedure. However, the training of the non-physician personnel who perform the diagnostic procedure and equipment maintenance are the responsibility of the physician. With direct supervision, the physician must be present in the office suite and immediately available to furnish assistance and direction throughout the performance of the procedure. However, the physician’s in-room presence is not required during the performance of the procedure. Personal supervision requires that the physician must be personally present in the room during the performance of the procedure. In ob/gyn ultrasound, general supervision is the standard, with the exception of percutaneous umbilical blood sampling, chorionic villus sampling (, amniocentesis, and sonohysterography/sonosalpingography, which require personal supervision.Inadequate supervision exposes physicians to greater liability risks and, potentially, claims of fraudulent billing.

    Inadequate equipment maintenance

    The quality of ultrasound equipment has improved exponentially. High-quality equipment is now within the budget of virtually any medical practice. As such, the expectation is that a practice will use contemporary equipment that has been properly maintained. Using equipment that is no longer supported by the manufacturer, generally due to the age of the equipment, implies that the practice is providing substandard care. Further, not performing proper preventive maintenance may result in poor image quality, increasing the liability risk for physicians and their practices. This author has witnessed cases turning on poor image quality from dated, or poorly maintained, ultrasound equipment.

    NEXT: Errors leading to litigation

    James M. Shwayder, MD, JD
    Dr. Shwayder is Professor and Chairman, Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson.


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